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The association of education with body mass index and waist circumference in the EPIC-PANACEA study

Silke Hermann1, Sabine Rohrmann137*, Jakob Linseisen12, Anne M May34, Anton Kunst5, Herve Besson36, Dora Romaguera7, Noemie Travier8, Maria-Jose Tormo10119, Esther Molina1112, Miren Dorronsoro1113, Aurelio Barricarte1114, Laudina Rodríguez15, Francesca L Crowe16, Kay-Tee Khaw17, Nicholas J Wareham6, Petra GA van Boeckel4, H Bas Bueno-de-Mesquita4, Kim Overvad1819, Marianne Uhre Jakobsen19, Anne Tjønneland20, Jytte Halkjær20, Claudia Agnoli21, Amalia Mattiello22, Rosario Tumino23, Giovanna Masala24, Paolo Vineis2526, Androniki Naska27, Philippos Orfanos27, Antonia Trichopoulou2728, Rudolf Kaaks1, Manuela M Bergmann29, Annika Steffen29, Bethany Van Guelpen30, Ingegerd Johansson31, Signe Borgquist32, Jonas Manjer33, Tonje Braaten34, Guy Fagherazzi35, Françoise Clavel-Chapelon35, Traci Mouw7, Teresa Norat7, Elio Riboli7, Sabina Rinaldi36, Nadia Slimani36 and Petra HM Peeters3

Author Affiliations

1 Division of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany

2 Institute of Epidemiology, Helmholtz Centre Munich, Neuherberg, Germany

3 Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands

4 National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands

5 Academic Medical Centre (AMC), University of Amsterdam, Amsterdam, The Netherlands

6 Medical Research Council, Epidemiology Unit, Institute of Metabolic Science, Cambridge, UK

7 Department of Epidemiology & Public Health, Imperial College London, London, UK

8 Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology, IDIBELL, Barcelona, Spain

9 Epidemiology Service, Murcia Health Council, Murcia, Spain

10 Preventive Medicine and Public Health Unit, Murcia Medical School, Murcia, Spain

11 CIBER Epidemiología y Salud Pública (CIBERESP), Spain

12 Andalusian School of Public Health, Granada, Spain

13 Public Health Department of Gipuzkoa, San Sebastian, Spain

14 Public Health Institute of Navarra, Pamplona, Spain

15 Public Health and Participation Directorate, Health and Health Care Services Council, Asturias, Spain

16 Cancer Epidemiology Unit, University of Oxford, Oxford, UK

17 Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK

18 Department of Cardiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark

19 Department of Clinical Epidemiology, Aarhus University Hospital, Aalborg, Denmark

20 Danish Cancer Society, Institute of Cancer Epidemiology, Copenhagen, Denmark

21 Nutritional Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

22 Department of Clinical and Experimental Medicine - Federico II University, Naples, Italy

23 Cancer Registry and Histopathology Unit, Department of Oncology, "Civile - M.P.Arezzo" Hospital, Ragusa, Italy

24 Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute (ISPO), Florence, Italy

25 ISI Foundation, Torino, Italy

26 Environmental Epidemiology, Imperial College London, London, UK

27 Department of Hygiene and Epidemiology, University of Athens Medical School, Athens, Greece

28 Hellenic Health Foundation, Greece

29 German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany

30 Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden

31 Department of Odontology, Umeå University, Umeå, Sweden

32 Department of Oncology, Lund University Hospital, Lund, Sweden

33 Department of Surgery, Malmö University Hospital, Malmö, Sweden

34 Institute of Community Medicine, University of Tromsø, Tromsø, Norway

35 Inserm ERI20 and Paris South University, Institut Gustave-Roussy, Villejuif, France

36 International Agency for Research on Cancer, Lyon, France

37 Insitute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland

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BMC Public Health 2011, 11:169  doi:10.1186/1471-2458-11-169

Published: 17 March 2011



To examine the association of education with body mass index (BMI) and waist circumference (WC) in the European Prospective Investigation into Cancer and Nutrition (EPIC).


This study included 141,230 male and 336,637 female EPIC-participants, who were recruited between 1992 and 2000. Education, which was assessed by questionnaire, was classified into four categories; BMI and WC, measured by trained personnel in most participating centers, were modeled as continuous dependent variables. Associations were estimated using multilevel mixed effects linear regression models.


Compared with the lowest education level, BMI and WC were significantly lower for all three higher education categories, which was consistent for all countries. Women with university degree had a 2.1 kg/m2 lower BMI compared with women with lowest education level. For men, a statistically significant, but less pronounced difference was observed (1.3 kg/m2). The association between WC and education level was also of greater magnitude for women: compared with the lowest education level, average WC of women was lower by 5.2 cm for women in the highest category. For men the difference was 2.9 cm.


In this European cohort, there is an inverse association between higher BMI as well as higher WC and lower education level. Public Health Programs that aim to reduce overweight and obesity should primarily focus on the lower educated population.

socioeconomic status; education; BMI; waist circumference; cohort study; EPIC